2026 Providers' Council Membership Renewal Form

Thank you for your commitment to the human services sector in Massachusetts. Let's keep the momentum of 50 years going. There is still so much work to be done and TOGETHER we will continue to move forward.

Please renew your Providers' Council membership today for January 2026 thru December 2026.

Type of Membership Renewing

PROVIDER Member Organization:
Please note: Your organization may be found under "T" if your agency's name starts with "The".

ASSOCIATE Member Organization:
Please note: Your organization may be found under "T" if your agency's name starts with "The".

Did your organization's mailing/billing address CHANGE in 2025?

YesNo

Please ensure the following information is up-to-date:

Address

Suite/Building #

City

State

Zip Code

Agency Phone Number

Membership Renewal Contact

Who should we reach out to at your organization in regards to membership?

First Name

Last Name

Job Title

President / CEO / Executive Leader

First Name

Last Name

Job Title

Financial Leader / CFO

Did Financial Leader CHANGE in 2025?

YesNo

Current Financial Leader Information

First Name

Last Name

Job Title

HR Leader / Human Resource Director

Did HR Leader CHANGE in 2025?

YesNo

Current HR Leader Information

First Name

Last Name

Job Title

Marketing/Comms Leader / Communications Director

Did Communications Leader CHANGE in 2025?

YesNoN/A Don't have position

Current Communication Leader Information

First Name

Last Name

Job Title

Learning / Training Director

Did Training Leader CHANGE in 2025?

YesNoN/A Don't have position

Current Training Leader Information

First Name

Last Name

Job Title

Public Policy Director

Did Public Policy Leader CHANGE in 2025?

YesNoN/A Don't have position

Current Public Policy Leader Information

First Name

Last Name

Job Title

Would you like to add additional contacts to this membership account?

Yes

Additional Contact(s)

Please let us know if anyone else at your organization would benefit from information about our marketing opportunities or human service sector news.
To add more than one person, click 'Add another person' below.

First Name

Last Name

Job Title

Organization Information

Approximate number of employees:

Full Time:

Part Time:

Volunteer:

Primary Funding Agency/Source (ex. DDS)

Other Funding Source(s):

Annual Revenue (ex. $2,050,100 from line 12 of your most recent 990):
Please attach a copy of the first page of the 990.

First Page of your most recent 990

Additional Financial Statements

Annual Revenue Range (based off line 12 of most recent 990).
This will be verified upon receipt of 990 information and payment received. We will reach out if there is a discrepancy.

2026 Membership Dues:

How would you like to pay your annual 2026 Provider membership dues?

Total Due for Provider Member Renewal

Would you like a link to your website posted on Providers' Council's website?

Yes

If yes, please share updated URL link below:

Would you be interested in a Providers' Council digital badge to include on your website?

Yes

Would you be interested in your organization being featured in a Providers' Council social media "Membership Monday" shoutout?

Yes

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Associate Membership

How would you like to pay your annual 2026 Provider membership dues?

Associate Membership Dues

ASSOCIATE MEMBERSHIP DUES $600

Note: Dues are not deductible as a charitable contribution.

FOUNDATION MEMBERSHIP DUES $1200

Note: Dues are not deductible as a charitable contribution.

Foundation Membership Dues include access to Delta Dental rates through the Council.

Associate Membership Dues: $

2026 Providers' Council Membership Renewal Form

Provider Member Benefits

Associate Membership